McNair Scholars Research Journal
Volume 7 | Issue 1
Article 7
Innovative Sexually Transmitted Infection
Prevention-Intervention for African-American
Adolescent Girls
Brialle D. Ringer
Eastern Michigan University, [email protected]
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McNair Scholars Research Journal: Vol. 7: Iss. 1, Article 7.
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Ringer: Innovative Sexually Transmitted Infection Prevention-Intervention
INNOVATIVE SEXUALLY TRANSMITTED
INFECTION PREVENTION-INTERVENTION
FOR AFRICAN-AMERICAN
ADOLESCENT GIRLS
Brialle D. Ringer
Pamela Landau, Mentor
ABSTRACT
The purpose of this study is to determine whether
implementation of an innovative STI prevention intervention
design affects participants’ knowledge of sexually transmitted
infections and sexual self-efficacy. The population this research
focuses on is African-American adolescent girls. The participants
included in this study are aged 13-19. This particular population
is disproportionately infected by sexually transmitted diseases, so
it is vital that intervention programs be tailored to fit their cultureand gender-specific needs in order to achieve maximum results.
However, current interventions for African-American girls
could be improved. The researcher has designed an innovative
STI prevention intervention that draws from current, bestevidence interventions. The researcher has hypothesized that: (1)
participants that complete the intervention will have increased
STI knowledge; and, (2) upon completion of the intervention,
participants will have greater sexual self-efficacy.
Innovative Sexually Transmitted Infection PreventionIntervention for African American Adolescent Females
African-American adolescent females are among the
highest risk population for contracting a sexually transmitted
infection (STI; Crepaz et al., 2009). This particular population
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experiences a combined increase of potential risk because they
are adolescent, female, and African American; data show that
groups tend to be disproportionately infected by STIs (Centers
for Disease Control and Prevention [CDC], 2000; CDC, 2012;
Crepaz et al., 2009; Sales et al., 2011). Engaging in risky sexual
behaviors further increases the risk of contracting an STI. For the
purpose of this study, sexual risk-taking behaviors refers to the
frequency of vaginal intercourse, number of sexual partners, or
frequency of condom use. Several intervention programs have
been designed to decrease sexual risk-taking behavior in AfricanAmerican females (CDC, 2013; Crepaz et al., 2009). However,
these programs alone do not sufficiently address the unique risks
African-American adolescent girls face.
African Americans continue to be disproportionately
affected by STIs such as HIV, gonorrhea, genital herpes, chlamydia,
and syphilis (CDC, 2000; CDC, 2012; Raiford, Seth, & DiClemente,
2012). African Americans account for 63% of all gonorrhea cases,
which is 30 times higher than the infection rate of Caucasians (CDC,
2000). African Americans also represent 65% of HIV diagnoses
(Raiford et al., 2012). Similarly, the Centers for Disease Control
and Prevention (2012) report that African-American females age
15-19 accounted for 7,719 cases per 100,000 females of chlamydia,
as well as 39.7% of primary and secondary syphilis cases. This is 23
times the rate that white women of the same age group experience
syphilis (CDC, 2012). The high prevalence of STIs in a population
that accounts for less than 12% of the United States population is
alarming, so it is critical to understand the factors that contribute to
their high risk (Crepaz et al., 2009).
Demographics including age, socioeconomic status, and
education account for the large disparity of STI between races.
“Social and economic conditions, such as high rates of poverty,
income inequality, unemployment, low educational attainment,
and geographic isolation can make it more difficult for individuals
to protect their sexual health” (CDC, 2012). Lower socioeconomic
status (SES) has been associated with less parental involvement,
which can result in adolescents engaging in higher sexual
risk-taking behaviors (Sionean et al., 2001). Neighborhoods
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characterized with lower SES also have higher prevalence rates
of STIs within the pool of potential sexual partners (Sionean et
al., 2001). With 1/3 of black men incarcerated or on probation,
and higher death rates for young black males, heterosexual
black females may have fewer options for black sexual partners
(Aidmora & Schoenbach, 2005). This creates a power imbalance
in favor of men. Limited male options and difficulty sustaining a
mutually monogamous relationship (due to males’ excess options)
may influence black women’s tolerance of concurrent sexual
partnerships (Aidmora & Schoenbach, 2005). Furthermore, in a
meta-analysis of behavioral interventions, Crepaz et al. (2009)
reported that several studies suggest that insufficient power in
African-American females’ relationships lead them to lack control
over condom use. Engaging in risky sexual behaviors, with little
parental guidance, in areas where STIs are more prevalent can
significantly increase the risk of contracting an STI.
As a demographic factor, age also contributes to potentially
hazardous biological predispositions faced by teens who engage
in sex at an earlier age. Biological factors such as cervical ectopy
and an immature immune system contribute to younger female
adolescents’ increased susceptibility to contracting an STI (Sales
et al., 2011). An underdeveloped nervous system is another
biological factor accounting for adolescents’ increased risk
(Casey et al., 2008). Decision-making in an adult brain involves
a cognitive-control network that favors rational outcomes, and
a socioemotional network that favors reward-based outcomes.
The cognitive-control network regulates behaviors of the
socioemotional network, producing fewer impulsive decisions.
However, since neither of these systems is fully matured in
adolescents’ brains, they are prone to higher impulsivity and
less able to make good judgments (Casey, Jones, & Hare, 2008;
Sales et al., 2011). These claims are supported by another study
(Bachanas et al., 2002, p. 526) that stated, “Younger teens who
are having sex seem especially vulnerable, as developmentally
they are least equipped cognitively and emotionally to handle the
demands of communicating with their partners about condom use
and delaying intercourse.”
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Self-efficacy is a main component in Bandura’s Social
Cognitive Theory, which defines it as “the belief that one can take
the necessary steps to produce desired outcomes” (Bandura, 1982;
Jemmott & Jemmott III, 1992). Bandura (1982, p. 123) stated:
Self-efficacy judgments, whether accurate or
faulty, influence choice of activities and environmental settings. People avoid activities that they
believe exceed their coping capabilities, but they
undertake and perform assuredly those that they
judge themselves capable of managing. Judgments of self-efficacy also determine how much
effort people will expend and how long they will
persist in the face of obstacles or aversive experiences. When beset with difficulties people who
entertain serious doubts about their capabilities
slacken their efforts or give up altogether, whereas those who have a strong sense of efficacy exert
greater effort to master the challenges. (p. 123)
Self-efficacy has three effects on behavioral outcomes,
according to Social Cognitive Theory: those with stronger selfefficacy are (1) more likely to attempt a behavior, (2) put forth
more effort to perform a behavior, and (3) exhibit more persistence
in their attempts to succeed (Bandura, 1982; O’Leary, Jemmott, &
Jemmott III, 2008).
In the present study, sexual self-efficacy is the
confidence to engage in safe sex practices in relation to partner
communication, sex refusal, and condom use (Sales et al., 2011).
Perceived self-efficacy is a significant mediator in the success of
intervention programs and, therefore, a strong predictor of sexual
behavior change in adolescents (Jemmott & Jemmott III, 1992;
O’Leary, Jemmott, & Jemmott III, 2008). “Perceived self-efficacy
has been shown to affect whether people consider changing their
behavior, the degree of effort they invest in changing, and longterm maintenance of behavioral change” (Jemmott & Jemmott
III, 1992, p. 273). In the multivariate mediation analysis study
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that revealed self-efficacy to be a significant mediator, O’Leary
et al. also reported expected partner reaction and partner approval
of condom use as significant mediators (O’Leary, Jemmott, &
Jemmott III, 2008). However, results indicated self-efficacy to be
the strongest mediator, implying that women’s determination for
condom use took precedence over anticipated partner reactions
(O’Leary, Jemmott, & Jemmott III, 2008). Increased self-efficacy
is best achieved through skill-building activities such as role-play
and practice in applying condoms on lifelike models (O’Leary,
Jemmott, & Jemmott III, 2008). In the current study, increased
self-efficacy is a primary goal, thus there are multiple skillbuilding opportunities within the intervention to help strengthen
participants’ confidence in practicing safe-sex behavior.
Unfortunately, little that can be done to change one’s
demographics, therefore intervention programs focus on addressing
modifiable factors associated with risky sexual behavior. Previous
studies have identified many factors that are correlated to increased
sexual risk-taking behavior. Among the factors, the following
are generally more statistically significant correlates: low selfefficacy, substance use and power abuse (Bachanas et al., 2002;
Raiford et al., 2012; Spitalnick et al., 2007).
Raiford et al. (2012) reported that girls who perceived
themselves as having less power in their relationship, and girls
who reported partner abuse, were more likely to test STI-positive.
Furthermore, in a meta-analysis of behavioral interventions,
Crepaz et al. (2009) suggest that insufficient power in AfricanAmerican females’ relationships lead them to lack control over
condom use. These findings demonstrate the importance of
promoting self-worth in intervention programs for young girls.
In a study that analyzed several factors of risky sexual
behavior, substance use was reported as the highest correlating
factor in the risky sexual behavior of African-American adolescent
girls. Thus, girls who reported high rates of substance abuse
also reported engaging in high rates of risky sexual behaviors
(Bachanas et al., 2002). Despite the reported increase in risky
behavior associated with substance use, the topic of substance
use is absent or under-emphasized in intervention programs
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for youth (CDC, 2013). In reviewing the Centers for Disease
Control and Prevention’s Compendium of Evidence-Based
HIV Behavioral Interventions (2013), I found only one “bestevidence” intervention targeted for African-American youth that
listed reduction in substance abuse to be a primary goal.
Focus on Youth (FOY) plus ImPACT targets highrisk African-American youth aged 12-16 living in low-income
urban community sites (CDC, 2013). FOY+ImPACT is a skillbuilding intervention with theoretical basis in the Protection
Motivation Theory (CDC, 2013). The intervention, designed
to reduce substance use and sex risk behaviors of high-risk
youth, is delivered to small groups of 5-12 participants (CDC,
2013). FOY delivers information on safe sex, drugs, alcohol,
drug selling, and STDs through the use of games, discussions,
and videos (CDC, 2013). The second part of the intervention,
ImPACT, is delivered to individual youth and their parents and
aims to increase parental monitoring and communication (CDC,
2013). This intervention explicitly discusses the role substance
use plays in STI risk (CDC, 2013). However, it is designed for
African-American girls and boys; therefore, it does not tap into
the important gender-specific factors related to adolescent girls’
increased risk (CDC, 2013).
An intervention program called Sistering, Informing,
Healing, Living, and Empowering (SiHLE) tailored the program
to fit the gender and cultural needs of African-American girls
aged 14-18 (CDC, 2013). The SiHLE intervention is a skills
training intervention intended to reduce risky sexual behavior.
The intervention’s theoretical constructs are derived from the
Theory of Gender and Power, and Social Cognitive Theory
(CDC, 2013). The intervention emphasizes ethnic and gender
pride and increases participants’ awareness of HIV risk reduction
strategies (CDC, 2013). Through the use of role-play, lectures, and
demonstrations, the intervention enhances confidence in initiating
safer-sex conversations and sexual refusal (CDC, 2013). Thus,
the intervention increases participants’ sexual self-efficacy (CDC,
2013). Additionally, the intervention facilitators demonstrate
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proper condom use and emphasize the importance of healthy
relationships (CDC, 2013). However, SiHLE does not incorporate
discussion about substance use (CDC, 2013).
Both of the previously described interventions may benefit
from incorporating strategies from multiple sources and theoretical
foundations, which is what this study will attempt to do. The researcher
has designed an STI prevention intervention for African-American
adolescent girls which incorporates the most important concepts from
the currently existing interventions SiHLE and FOY+ImPACT. The
intervention’s primary goals are to increase participants’ protective
factors, (1) STI knowledge and (2) sexual self-efficacy. Increasing
participants’ STI knowledge and self-efficacy provides them with
the necessary foundation to engage in safer sex practices in order to
decrease their risk of contracting an STI.
METHOD
Participants
Participants in this study will be sexually active (within
the last 60 days), African American, adolescent girls, aged 13-19.
The researcher will recruit 20 participants from a Detroit public
health clinic for youth, Oakwood Inkster Teen Health Center.
Participants will be recruited using nonprobability convenience
sampling, due to the private nature of the health clinic. Contact
information and a brief description of the study will be posted on
flyers in the waiting room. Prospective participants who contact
the researcher will be told the purpose of the study and be invited
to participate if they fit inclusion criteria (heterosexually active,
African American, female, aged 13-19). Participants attempting
to become pregnant, currently pregnant, and married women
will be excluded from the study. If a participant is interested in
joining the study she will be given an informed consent form
(participants 18 and over). Participants under the age of 18
will be given an informed assent form, as well as an informed
consent form for their parents/guardians to fill out and return.
The researcher will seek IRB approval from Eastern Michigan
University prior to data collection.
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MEASURES
Demographics
A questionnaire will be completed by participants, prior to
the intervention, which seeks the following demographic data: age,
education, household monthly income, and poverty level. Participants
will also be asked whether they have or have had an STI.
Sexually Transmitted Infection
Participants will provide self-collected vaginal swab
specimens pre-intervention. Specimens will be sent to a laboratory
to screen for chlamydia, gonorrhea, and trichomonas. The specimen
will be screened for bacterial pathogens using BDProbeTec ET
Chlamydia trachomatis and Neisseria gonorrhoeae Amplified
DNA Assays. Trichomonas vaginalis will be identified by a
noncommercial real-time polymerase chain reaction assay (Sales
et al., 2011). A participant testing positive for one or more STIs
will be noted as “STI positive.” Participants will be informed
of any positive results and offered appropriate treatment of the
sexually transmitted infection.
The following are self-administered surveys that
participants will take pre- and post-intervention. These surveys
will measure the participants’ STD knowledge and sexual selfefficacy. The researcher has hypothesized that implementation of
the devised culturally and gender specific intervention will (1)
increase STD knowledge and (2) increase sexual self-efficacy. The
construct of the scales mentioned below will allow the researcher
to determine the effectiveness of the intervention.
STI/HIV Knowledge
Participants’ HIV and STI related knowledge will be
assessed using the HIV Knowledge Questionnaire (HIV-K-Q;
Carey, Morrison-Beedy & Johnson, 1996). HIV-K-Q is a 45-item,
true-or-false scale designed to measure knowledge of transmission,
risk reduction strategies, and consequences of infection. Sample
items include “Taking a test for HIV 1 week after having sex will
tell a person if he or she has HIV,” and “Showering, or washing
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one’s genitals after sex keeps a person from getting HIV.”
Responses are coded so that higher scores signify greater HIV
knowledge, and lower scores indicate less HIV knowledge. HIVK-Q is reported reliable (internally consistent with alpha = .91),
and valid (Carey, Morrison-Beedy, & Johnson, 1996).
Sexual Self-Efficacy
Sexual self-efficacy will be assessed using The AIDS
Prevention Self-Efficacy Scale (Kasen, Vaughan, & Walter,
1992). The 22-item scale measures the participants’ confidence
to refuse sexual intercourse, question potential sexual partners
and use condoms. Sample items include “How sure are you that
you would be able to say NO to having sex with someone you
have known for a few days or less?”; “How sure are you that you
would be able to ask your boyfriend about sexual relations that he
has had in the past?”; and “How sure are you that you would be
able to use a condom correctly?” Items are measured on a fivepoint scale with responses ranging from “(1) not at all sure” to
“(5) very sure.” Possible scores range from 22 to 110, with higher
scores indicating higher self-efficacy to perform HIV-preventive
behaviors. Internal consistency (Cronbach’s alpha .76–.81) has
been reported in adolescent populations for The AIDS Prevention
Self-Efficacy Scale (Kasen, Vaughan, & Walter, 1992).
PROCEDURE
The intervention is broken into 3 sessions, lasting approximately
4 hours each. Each is a small group session designed to promote
bonding and discussion of shared experiences. Groups will consist
of 5-10 participants led by a highly trained, African-American
female facilitator. The facilitator will actively involve participants
in discussions, games, videos and role play. The facilitator will
deliver information in a non-judgmental way and establish a
positive environment that empowers participants. The sessions
will provide education about the risks and realities of STIs, build
skills necessary to engage in safer sex practices, and improve
confidence in carrying out those skills. An incentive of $20 will
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be provided to participants for attending the first session, and $15
will be provided for each subsequent session. The intervention
design was derived from an unnamed STI preventive behavioral
intervention (Shain, Piper, Newton, et al., 1999), SiHLE,
FOY+ImPACT, and intervention mapping strategies described by
Tortolero, Markham, Parcel, et al. in 2005.
After agreeing to participate in the study, the initial
pre-intervention visit will consist of collecting baseline data.
Participants will complete the self-administered questionnaires.
Participants will then be instructed by a trained professional on
how to collect vaginal fluid using a lifelike model of a vagina.
The self-collected vaginal swabs will be delivered to a nearby
laboratory and tested for chlamydia, gonorrhea, and trichomonas.
Participants will then choose a date to begin the intervention.
Session 1: Inform.
The first session of the intervention focuses on informing
participants about risks and facts related to sexually transmitted
infection. The session will teach girls about the transmission of STIs,
how to detect symptoms (pictures), and behavior that increases
the risk of contracting an STI. Participants will be informed of
their increased risk of acquiring an STI as African-American
adolescent females. Risk
will be discussed as a
problem related to biologic
susceptibility and poverty,
not skin color. The lecture
will include power point
slides and pictures to
simplify difficult concepts.
Participants will also be
shown “Black Iris”, by
Georgia O’Keeffe (Figure
1). which metaphorically
resembles the beauty of
female genitalia. Showing
participants the art is
Figure 1. “Black Iris” by Georgia O’Keeffe.
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designed to increase their self-esteem and allow them to view their
bodies in a more positive light. The session will end with a video
of real people with AIDS to demonstrate the potential effects of
getting an STI and its impact on relationships. Trivia questions
on important concepts will be administered throughout to keep
participants engaged.
Session 2: Intervene
The focus of Session 2 is on teaching participants
preventive strategies to engage in, and situations to avoid, in
order to decrease their risk of infection. This session will consider
barriers of condom use, including explicit discussions of gender
and power abuse in relationships, and the danger of substance
use. Participants will learn what to ask partners about current
behavior and history. The facilitator will define and discuss power
imbalanced relationships, dating violence and challenges of
dating older males. Participants will be taught the risks associated
with substance use (alcohol and illicit drugs), including damaging
health effects and higher sexual risk behavior. This session seeks to
increase participants’ sense of self-worth and self-esteem through
open discussions regarding participants’ individual experiences.
Session 3: Empower
The final session provides skill-building opportunities to
apply the knowledge gained in earlier sessions. Participants will
learn about correct condom use and practice condom application
on plastic penis models. Session 3 aims to increase communication
skills in regard to sex negotiation and condom use through roleplay with a male facilitator. The facilitator will discuss triggers of
unsafe sex, and participants will brainstorm strategies to get out
of situations they feel may result in unsafe sex. Participants will
set goals for themselves and discuss limitations they foresee in
regards to reaching their goals. The facilitator will address these
concerns and end the session by providing information about local
resources, and encourage participants to share information and
build peer support.
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Upon completion of the intervention participants will
retake The HIV Knowledge Questionnaire and The AIDS
Prevention Self-Efficacy Scale to assess the effectiveness of the
program. Participants will also be debriefed, during which their
concerns will be addressed. During the debriefing process they will
be given informative brochures, condoms, and a list of referrals
(counseling, STI testing centers and additional community
resources) to encourage continued safe-sex practices.
PLAN FOR ANALYZING RESULTS
The researcher will analyze the demographic
characteristics and report participants’ mean age and years of
education. The range of household monthly income will be
reported, as well as the average number of participants above and
below the poverty level. Total cases of positive STI results will be
recorded. Data on participants who miss an intervention session or
do not complete the study will be excluded from analyses.
The first hypothesis in this study is that participants
who complete the intervention will be more knowledgeable
about sexually transmitted infections. The researcher will
test this hypothesis using a directional one-tailed t-test with a
significance level of .001. A directional test was chosen because
the researcher hypothesizes an increase in STI knowledge. The
mean of scores will be assessed for the pre-intervention and postintervention data drawn from The HIV Knowledge Questionnaire.
A difference score will be calculated by subtracting one set of the
pair of scores from the other. A calculation using the difference
score will determine an estimate of the standard deviation. The
researcher will calculate obtained t-value by subtracting the mean
of difference scores (0) from the difference score and dividing this
value by the estimated standard deviation. The critical value for
df= 19 and p= .001 is 3.579. If the obtained t-value is higher than
3.579, the researcher will accept the hypothesis as true.
The second and final hypothesis in this study was that
upon completion of the intervention, participants will have higher
sexual self-efficacy. Researchers will test this hypothesis using a
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directional one-tailed t-test with a significance level of .001. A
directional test was chosen because the researcher hypothesizes
an increase in sexual self-efficacy. The mean of scores will be
assessed for the pre-intervention and post-intervention data of The
AIDS Prevention Self-Efficacy Scale. A difference score will be
calculated by subtracting one set of the pair of scores from the
other. A calculation using the difference score will determine an
estimate of the standard deviation. The researcher will calculate
obtained t-value by subtracting the mean of difference scores (0)
from the difference score and dividing this value by the estimated
standard deviation. The critical value for df= 19 and p= .001 is
3.579. If the obtained t-value is higher than 3.579, the researcher
will accept the hypothesis as true. Thus, the intervention increased
participants’ sexual self-efficacy.
DISCUSSION
This study attempts to assess potential improvements
in STI prevention-interventions designed for African-American
adolescent girls. Prevalence rates among young black women
continue to rise, and it is vital that we address the issue in a
manner best suited for their culture- and gender-specific needs.
The researcher designed a unique intervention that aims to do just
that. This study is a plan for future implementation, but in the
meantime, current interventions should consider the concerns and
possible solutions laid out in this intervention.
REFERENCES
Adimora, A. A., & Schoenbach, V.J. (2005) Social context, sexual networks, and racial
disparities in rates of sexually transmitted infections. The Journal of Infectious
Disease, 191(1) S115-S122. doi: 10.1086/425280.
Bachanas, P. J., Morris, M. K., Lewis-Gess, J. K., Sarett-Cuasay, E. J., Sirl, K., Ries, J. K., &
Sawyer, M. K. (2002) Predictors of risky sexual behavior in African American
adolescent girls: implications for prevention interventions. Journal of Pediatric
Psychology, 27(6), 519-530. Retrieved from http://jpepsy.oxfordjournals.org/
content/27/6/519.full.pdf+html.
Bandura, A. (1982) Self-Efficacy mechanism in human agency. American Psychologist,
37(2), 122-125.
Carey, M. P., Morrison-Beedy, D., & Johnson, B. T. (1996) The HIV-Knowledge
Questionnaire: Development and Evaluation of a Reliable, Valid, and Practical
71
Published by DigitalCommons@EMU,
13
McNair Scholars Research Journal, Vol. 7 [], Iss. 1, Art. 7
Brialle D. Ringer
Self-Administered Questionnaire. AIDS and Behavior, 1. Retrieved from
file://itlabsprofiles/folders$/bringer/Downloads/HIV%20Knowledge%20
Questionnaire%20AIDS%20and%20Behavior.pdf.
Casey, B. J., Jones, R. M., & Hare, T. A. (2008) The adolescent brain. Annals of the New
York Academy of Sciences, 1124, 111-126. doi:10.1196/annals.1440.010.
Center for Disease Control and Prevention (2000) African Americans disproportionately
affected by STDs. Retrieved from http://www.cdc.gov/stdconference/2000/
media/afamericans2000.htm.
Center for Disease Control and Prevention (2013) Compendium of Evidence-Based HIV
Behavioral Interventions. Retrieved from http://www.cdc.gov/hiv/prevention/
research/compendium/rr/complete.html.
Center for Disease Control and Prevention (2012) STDs in racial and ethnic minorities.
Sexually Transmitted Disease Surveillances. Retrieved from http://www.cdc.
gov/std/stats12/minorities.htm.
Crepaz, N., Marshall, K., Aupont, L., Jacobs, E. D., Mizuno, Y., Kay, L., Jones, P., McCree,
D. H., & O’Leary, A. (2009) The Efficacy of HIV/STI Behavioral Interventions
for African American Females in the United States: A Meta-Analysis. American
Journal of Public Health, 99(11). Retrieved from http://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2759779/.
Dorio, C., Parsons, M., Lehr, S., Adame, D., & Carlone, J. (1992) Measurement of Safe Sex
Behavior in Adolescents and Young Adults. Nursing Research, 41(4). Retrieved
from
http://journals.lww.com/nursingresearchonline/Abstract/1992/07000/
Measurement_of_Safe_Sex_Behavior_In_Adolescents.3.aspx.
Jemmott, L. S., & Jemmott III, J. B. (1992) Increasing condom-use intentions among
sexually active black adolescent women. Nursing Research, 41(5), 273-279.
Kaestle, C. E., Halpern, C. T., Miller, W. C., & Ford, C. A. (2004) Young age at first sexual
intercourse and sexually transmitted infections in adolescents and young adults.
American Journal of Epidemiology, 161(8). doi:10.1093/aje/kwi095.
Kasen, S., Vaughan, R. D., & Walter, H. J. (1992) Self-Efficacy for AIDS Preventive
Behaviors among Tenth Grade Students. Health Education & Behavior, 19.
DOI: 10.1177/109019819201900204.
Lee, Y., Salman, A., & Fitzpatrick, J. J. (2009) HIV/AIDS preventive self-efficacy,
depressive symptoms, and risky sexual behavior in adolescents: A crosssectional questionnaire survey. International Journal of Nursing Studies, 46(5),
653-660. http://dx.doi.org/10.1016/j.ijnurstu.2008.11.007 .
O’Leary, A., Jemmott III, J. B., Jemmott, L.S. (2008) Mediation analysis of an effective sexual
risk-reduction intervention for women: the importance of self-efficacy. Health
Psychology, 27(2) (Suppl.), S180-S184. DOI: 10.1037/0278-6133.27.2(Suppl.)S180.
Raiford, J. L., Seth, P., & DiClemente, R. J. (2012) What girls won’t do for love: human
immunodeficiency virus/sexually transmitted infections risk among young
African-American women driven by a relationship imperative. Journal of
Adolescent Health, 52, 566-571. doi:10.1016/j.jadohealth.2012.09.006.
Sales, J. M., Brown, J. DiClemente, R. J., Davis, T. L., Kottke, M. J., & Rose, E. S.
(2011). Age differences in STDs, sexual behaviors, and correlates of risky sex
among sexually experienced adolescent African-American females. Journal of
Pediatric Psychology, 37(1), 33-42. doi:10.1093/jpepsy/jsro76.
Shain, R. N., Piper, J. M., Newton, E. R., Perdue, S. T., Ramos, R., Champion, J. D.,
& Guerra, F. A. (1999). A randomized, controlled trial of a behavioral
intervention to prevent sexually transmitted disease among minority women.
The New England Journal of Medicine, 340(2), 93-100. DOI: 10.1056/
NEJM199901143400203.
72
http://commons.emich.edu/mcnair/vol7/iss1/7
14
Ringer: Innovative Sexually Transmitted Infection Prevention-Intervention
Innovative Sexually Transmitted Infection Prevention-Intervention
for African-American Adolescent Girls
Sionean, C., Diclemente, R. J., Wingwood, G. M., Crosby, R., Cobb, B. K., Harrington, K.,
Davies, S. L., Hook III, E. W., & Kim Oh, M. (2001). Socioeconomic status and
self-reported gonorrhea among African American female adolescents. Journal
of the American Sexually Transmitted Diseases Association, 28(4), 236-239.
Retrieved from http://journals.lww.com/stdjournal/Abstract/2001/04000/
Socioeconomic_Status_and_Self_reported_Gonorrhea.9.aspx.
Spitalnick, J. S., DiClemente, R. J., Wingwood, G. M., Crosby, R. A., Milhausen, R. R.,
Sales, J. M., McCarty, F., Rose, E., & Younge, S. N. (2007). Brief report:
sexual sensation seeking and its relationship to risky sexual behavior among
African-American adolescent females. Journal of Adolescence, 30, 165-173.
Doi:10.1016/j.adolescence.2006.10.002.
Tortolero, S. R., Markham, C. M., Parcel, G. S., Peters, R. J., Escobar-Chaves, S. L., BasenEngquist, K., & Lewis, H. L. (2005). Using Intervention mapping to adapt an
effective HIV, sexually transmitted disease, and pregnancy prevention program
for high-risk minority youth. Sage. DOI: 10.1177/1524839904266472.
73
Published by DigitalCommons@EMU,
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